How clean hands can save lives during the COVID-19 pandemic

Handwashing with soap is the first line of defence against COVID-19. But without active support to improve water, sanitation and hygiene, the world is much more likely to experience prolonged and repeated pandemics.

On June 1^st, 9-year-old Stephen Wamukota received the Kenyan presidential award for inventing a pedal-operated hand-washing machine. The contraption, fashioned out of his father’s window frames, allows users to tip water onto their hands without touching any surfaces. Now appearing across neighbouring villages in his home of Bungoma County, Stephen’s machine typifies the ingenuity of many African communities fighting to curb the spread of COVID-19.

But the story is not all rosy. Stephen’s invention underscores deep structural weaknesses in water, sanitation and hygiene across many African countries. In Kenya, only half of the population has access to safe water, while less than a third are connected to proper sanitation. In the Democratic Republic of Congo, less than half of the health facilities in operation have reliable supplies of soap to allow basic protection for frontline health workers.

Lockdowns are adding further pressure. Travel restrictions have forced many households towards more accessible but far more unsanitary water sources such as shallow wells. And in slums, where clean water is typically expensive, intermittent, and often shared across households, waiting in line for water itself poses a major transmission risk. Governments that order people to wash their hands, but fail to provide the facilities to do so, are only causing more anxiety.

Effective policy responses will need to focus on immediate expansion of WASH facilities as well as longer-term resilience. But the challenge often requires balancing the costs of infrastructure with the incentives of consumers, ensuring that water meets appropriate standards, but is still affordable for the poorest households. Both observations come from a recent IGC policy brief. It illuminates the scale of the challenge and highlights why solving Africa’s water crisis has never been more important.

Five steps for improving WASH during COVID-19:

1. Policymakers should identify areas for emergency expansion of handwashing facilities such as soap stations and alcohol-based handrubs. As during the Ebola outbreak, West African countries have swiftly and effectively deployed plastic water containers nicknamed “Veronica buckets" across the city. Much like Stephen’s machine, these are simple and low-cost solutions that provide a safe means of handwashing and waste disposal despite the absence of running water. To be most effective, such policies should be bolstered with data collection so they can be targeted towards identifying risk areas and key user groups such as health facilities, schools, offices, malls, markets and informal settlements.
2. Provide clear, actionable and consistent messaging. One of the biggest challenges during the Ebola outbreak was the spread of misinformation and a general lack of trust in public officials leading the response. As a result, many Sierra Leoneans delayed taking up preventative behaviours and were also reluctant to report new cases in their communities. The government rectified this by engaging with respected community leaders and supporting research to better understand transmission risks and behaviours. What we have learnt is that the most effective campaigns tend to be those that emphasise a few core messages rather than giving long lists of dos and don’ts. People also tend to pay most attention when the messages are locally-driven. Today, these lessons are being applied to COVID-19, with Sierra Leone marshalling radio celebrities and Mammy Queens (female leaders) to disseminate factual and culturally-sensitive health messages during the pandemic.
3. A third component of the response toolkit involves taking conscious steps to monitor and reduce water waste. In Cape Town, for example, efforts to improve pipe conditions have helped the city to reduce its water consumption by 50% in just 3 years, following major droughts starting in 2015. Reforms to digitise and frequently update daily administrative data played a key role in supporting the city to identify and fix leaks. Data was also used throughout communications campaigns such as #everydropcounts so that citizens could rally around a collective effort to reduce consumption.
4. We have to recognise that institutions matter. Even with quality infrastructure in place, without institutions to incentivise demand, citizens often continue with the informal systems that encompass much of the urban fabric in developing cities. For instance, even though New York opened a revolutionary and hugely expensive new water system called the Croton Aqueduct in 1842, the 1849 cholera outbreak led to more deaths than its predecessor in 1832. Death rates remained high because connection fees were expensive, and just as in sub-Saharan Africa today, poorer individuals chose to avoid the costs. Overcoming this ‘last mile problem’ requires government – including international government – to incentivise connections through subsidies and loans.
5. Finally, given the global burden of disease, the global community has to take responsibility for improving WASH across the developing world. This will be particularly important for rapidly growing developing cities. Of the roughly 30 major global epidemics in world history, the last four happened in the last 30 years, and all were started and rapidly spread in urban areas. With fast-growing cities, the time imperative for infrastructure is absolutely critical, but the up-front costs often delay investments from taking place. Without international support to shoulder the burden of investment, developing cities can end up locked into ineffective systems that are extremely costly to replace at later dates.

It is important to remember that most European and American cities did not have good sources of clean water when they were first afflicted with global cholera pandemics in the early 19^th century. The issue led to thousands of deaths, but did inspire renewed focus on water and sanitation. The same focus must be applied to the developing world, perhaps through different mechanisms, but with the same end-goal of making our world much healthier.

This blog is part of a series curated by the Cities that Work initiative exploring topics on cities and the ongoing COVID-19 pandemic. Read more. 

Editor's note: An IGC policy brief, 'Water, sanitation, and hygiene policy in the time of COVID-19', from this series can be found here.

Disclaimer: The views expressed in this post are those of the authors based on their experience and on prior research and do not necessarily reflect the views of the IGC.